Sunday, August 14, 2011

Medical Ethicists as Secular Priests

...I have been appointed to ad hoc committees on sensitive administrative problems (such as what to do about a resident who was HIV positive but wanted to stay in the program), even though ethical expertise was not much needed. In such cases I have come to see myself as cast into the role of a “secular priest”: even in a pluralistic and multiethnic society someone must sanctify such delicate proceedings. (pages 14-15)

In psychotherapy the phenomenon Moreno is describing would be seen as "transference" - a perception of the therapist that arises from within the patient, not from a realistic perception of the therapist.

In simplest terms, the therapist has two choices to make with regard to transference - use it to advance the goals of treatment, or interpret it as an opportunity for insight.

The ethics consultant must make a similar choice about the "secular priest" transference. If the group the consultant is meeting with has worked hard and reached a thoughtful, well-reasoned conclusion, but then asks - "what do you think?" - the consultant might accept the "secular priest" role and "bless" the group's work, as by responding - "I'm impressed with the thoughtfulness and depth of the discussion - it looks as if we're all comfortable with where we came out."

One reason for accepting the "secular priest" transference this way would be to encourage the participants to see themselves as competent to grapple with challenging ethical questions. Another reason would be to reinforce their commitment to the method(s) of problem solving they had applied.

But suppose the group has reached an overly certain conclusion about an ambiguous question that isn't susceptible to the kind of closure the group settled on. Here the "priest" might choose to "bless" uncertainty: "We all prefer certainty to uncertainty. That's why Harry Truman only wanted advice from one-armed economists - so that he wouldn't hear "on one hand...on the other hand"! But sometimes certainty is an illusion. I suggest that we go back to the drawing board on this..."

I feel squeamish when I'm introduced as an "ethicist." Since questions about what's the right thing to do come up every day of our lives, we're all "ethicists." Sometimes I make that point. But when I feel the situation requires a "secular priest" I bite my tongue and accept the label.

But there's a serious risk in following that path - we might come to believe the attribution ourself!